Download - Initiating AMS at BCCH
Initiating an Antimicrobial Stewardship Program at
BC Children's Hospital
Quality Forum 2015Ashley Roberts, MD, M.Ed, FRCP(C)
Karen Ng, BSc.Pharm, ACPR, PharmD, BCPSFebruary 19, 2015
Disclosures• We have no conflicts of interest to
declare
Goals of Antimicrobial Stewardship
• Reduce risk of infections• Reduce adverse drug events related to
antimicrobial use• Reduce or stabilize antibiotic resistance• Promote patient safety
“to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use”
BC Children’s Hospital Antimicrobial Stewardship
Program• 180-bed tertiary care
academic hospital and major referral centre for acutely ill or injured children
• Antimicrobial Stewardship Program implemented September 2013
Challenges of Implementing a Pediatric Antimicrobial Stewardship Program
(ASP)
• Limited evidence vs. adult programs for ASP implementation
• Fragilities of neonatal and pediatric population
• Limited evidence and treatment guidelines for pediatric infections
Pharmacother 2012;32(8):735-743.
Key #1
Collaboration• “Collective Ownership”• Promote Mutual Learning
1. CollaborationAntimicrobial Stewardship Team at BC Children’s and Women’s Hospital
ASP Member RoleDr. Ashley Roberts PHSA AMS Director, Infectious Diseases SpecialistDr. Simon Dobson Co-chair, Infectious Diseases Specialist, Infection
PreventionistDr. Karen NgDr. Vanessa Paquette
Clinical Pharmacy Specialists
Dr. Peter Tilley Medical MicrobiologistDr. Srinivas MurthyDr. Rod RassekhDr. Joseph Ting
Pediatric Intensive Care ChampionOncology AMS ChampionNeonatal Intensive Care Champion
Dr. Roxane Carr Pharmacy Clinical Coordinator
Form an effective multidisciplinary AMS team of core members.
1. CollaborationAntimicrobial Stewardship Team at BC Children’s and Women’s Hospital
ASP Member RoleDr. Ashley Roberts PHSA AMS Director, Infectious Diseases SpecialistDr. Simon Dobson Co-chair, Infectious Diseases Specialist, Infection
ControlDr. Karen NgDr. Vanessa Paquette
Clinical Pharmacy Specialists
Dr. Peter Tilley Medical MicrobiologistDr. Srinivas MurthyDr. Rod RassekhDr. Joseph Ting
Pediatric Intensive Care ChampionOncology AMS ChampionNeonatal Intensive Care Champion
Dr. Roxane Carr Pharmacy Clinical Coordinator
Form an effective multidisciplinary AMS team of core members.
PARTNERSHIP WITH MICROBIOLOGY IS ESSENTIAL•Antibiogram production• Bacterial susceptibility breakpoints tailoring and antimicrobial dose
optimization•Microbiology reports and comments modifications•Implementation of new guidelines/initiatives
1. CollaborationAntimicrobial Stewardship Team at BC Children’s and Women’s Hospital
ASP Member RoleDr. Ashley Roberts PHSA AMS Director, Infectious Diseases SpecialistDr. Simon Dobson Co-chair, Infectious Diseases Specialist, Infection
ControlDr. Karen NgDr. Vanessa Paquette
Clinical Pharmacy Specialists
Dr. Peter Tilley Medical MicrobiologistDr. Srinivas MurthyDr. Rod RassekhDr. Joseph Ting
Pediatric Intensive Care ChampionOncology AMS ChampionNeonatal Intensive Care Champion
Dr. Roxane Carr Pharmacy Clinical Coordinator
Form an effective multidisciplinary AMS team of core members.
IDENTIFY ASP CHAMPIONSPhysicians with interest in infectious diseasesPromotes collaboration and acceptance of ASP interventionsExpands opportunities for research
• Example: Partnership with NSQIP (National Surgical Quality Improvement Program)
1. Collaboration
Key #2
Optimize Available Resources
AMS Pharmacist
12
AMS Pharmacist
13
Key #2: Optimize Available Resources
Teamwork-driven daily prospective audit and feedback
• Microbiology liaison
• Infection Control liaison
• Infectious Diseases team
• Partnership with clinical pharmacists
Key #3
Adapt Strategies to Your Site
• Understand local culture and attitudes• Evaluate “worst offenders”• Establish achievable goals
Key #3: Adapt Strategies to Your Site
Strategies Used/Adopted Strategies Bypassed
Daily prospective audit and feedback
Formulary restrictions
Dose optimization Automatic stop ordersEducation, development of guidelines and order sets
Preauthorization requirements
Active surveillanceOngoing research
At BC Children’s Hospital:
Key #3: Adapt Strategies to Your Site
cefotaxime/ceftriaxonevancomycin
1st-gen cephalosporinsamoxicillin/ampicillin
aminoglycosidespiperacillin/tazobactam
metronidazole cloxacillin
clindamycinmeropenem
acyclovirfluconazole
ciprofloxacinmacrolidesamox/clav
voriconazole2nd-gen cephalosporins
sulfamethoxazole-trimethoprimOther
0 50 100 150 200 250 300 350 400 450Cumulative # Interventions in 2014
•Most ASPs target specific antimicrobials in audit and feedback.•BC Children’s Hospital experience: Audit all antimicrobials
Adapting Antimicrobial Stewardship to the Pediatric Population…
Reflections and Lessons Learnt
• Limited evidence requires greater flexibility, discussion and collaboration
• Continual reassessment and readjustment of ASP strategies and initiatives
• Must not forget the humanistic factor • Data collection and analyses are crucial
“from restriction to facilitation”Am J Health Syst Pharm 2011;68:109-10
Summary: Keys to Success
Initiating an ASP in a Pediatric Hospital
1. Collaboration
2. Optimize available resources
3. Adapt strategies to local culture and attitudes
Questions?
Ashley [email protected]
Karen [email protected]
604-875-2000 ext 5952Pager: BCCH Antimicrobial Stewardship